ACOUSTIC NEUROMA SURGERY - OUTCOME ANALYSIS OF PATIENT-PERCEIVED DISABILITY

Objective: Numerous studies have investigated the outcome of acoustic neuroma (AN) treatment using classical medical measures. In an effort to describe the long-term Lifestyle consequences of AN removal from th e patient's perspective, patients filled out detailed questionnaires c oncerning their functional status. Study Design: This was a retrospect ive survey. Setting: This study was performed at a tertiary referral c enter. Patients: A total of 130 late postoperative acoustic neuroma pa tients were surveyed a minimum of 6 months following surgery (average, 39 months). Survey response rate was 65% (130/200). Main Outcome Meas ures: The main outcome measures were the patient's perception of their hearing, balance, facial expression, and eye function in relation to its impact upon the activities of daily life. A comparison of pretreat ment with long-term posttreatment functional levels. Results: When ask ed to designate their ''most significant'' symptom, hearing loss was b y far most prevalent (61.3%), followed by balance troubles (14.3%) and facial weakness (10.1%). The relatively low incidence of facial weakn ess as the patient's dominant complaint was somewhat surprising. When considering the incidence of each symptom, women were more likely to c omplain of facial weakness, dry eye, and headache, whereas men had a m arginally higher incidence of hearing loss and imbalance. Patient age had no apparent influence upon either the distribution or severity of symptomatic complaints. Both hearing in the tumor ear and overall audi tory function (e.g., the ability to understand in a restaurant) tended to worsen following surgery One finding, which was both unanticipated and intriguing, was the improvement in sound localization ability rep orted by 57% of patients following surgery. Although the proportion of patients complaining of frequent tinnitus increased postoperatively, the number of patients who found the tinnitus troublesome decreased ma rkedly. In terms of balance function, only 31% preoperatively and 15% postoperatively described themselves as free of balance difficulties. An aid to ambulation (e.g., cane, walker) was needed in five patients (4%) preoperatively, two of whom regained the ability to walk independ ently following tumor removal. Conclusions: These functional outcome d ata provide much useful information to both patient and clinician to c onsider when contemplating the optimal course of AN management. Althou gh virtually all acoustic neuroma patients have some degree of persist ent symptoms over the long-term, the data indicates that most of these are attributable to the tumor itself as opposed to the after effects of its surgical removal. The relatively slight differences between pre operative and late postoperative symptom profiles was a rather unantic ipated finding. As the degree of disability tends to increase with lar ger tumor sizes, these data tend to support a policy of early interven tion.